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“Anonymous Testing or Confidential Testing? What's Best For Me?"

“Anonymous Testing or Confidential Testing? What's Best For Me?"

Although oral sex is considered low risk
for HIV transmission, there have been a
very small number of people who
became infected with HIV through
unprotected oral sex (mouth to vagina or
mouth on penis). The risk is greater if
there are cuts or sores on the mouth,
penis or vagina.
“Anonymous Testing or Confidential
Testing? What’s best for me?”
• Anonymous testing uses a number or a
code on your lab slip instead of your
name. Only you will know your test
result, or even that you were tested.
Anonymous testing is only available at
selected health clinics. Anonymous tests
are not done by family physicians. To
find out the location of your nearest
anonymous testing site, contact the
AIDS-Sexual Health InfoLine at
416-392-2437 (outside Toronto
1-800-668-2437).
• Confidential testing means your test
result will appear in your medical
record. Only you and your physician will
know this information. In rare instances
legal authority could be used to access
your medical record.
“What if I am asked to take the test for
employment or insurance reasons?”
In this case you may first want an
anonymous test done. If your anonymous
test result is positive, you may choose to
withdraw your employment or insurance
application to protect your confidentiality.
For more information about
HIV antibody testing,
or for the location of your
nearest anonymous testing site,
call the AIDS-Sexual Health InfoLine
at 416-392-2437
(outside Toronto 1-800-668-2437).
Revised and reprinted by
Toronto Public Health
with permission of the
AIDS Committee of Toronto

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HIV Tests

THE HIV ANTIBODY TEST
This brochure is designed to help answer
questions you may have if you are thinking
about taking the HIV antibody test. HIV
stands for Human Immunodeficiency Virus
and is the virus that causes AIDS.
This brochure is not a substitute for
counselling before and after you take the
test. Before you decide to take the test, you
may want to talk to someone who can
answer your questions and concerns about
the testing process. The AIDS- Sexual
Health InfoLine at 416-392-2437 (outside
Toronto 1-800-668-2437) can help you.

WHY TAKE THE TEST?
There is no easy answer to this question.
For some people testing is important
because they want to know whether they are
infected or not. They may also want to
know their HIV status so that they can take
additional steps to remain healthy.
Other people do not want to know their HIV
status. They may not want to deal with the
possibility of being infected with HIV. Only
you can decide if the time is right to get
tested. To make that decision, it is helpful to
have a clear understanding of what the test
is and what the result means.

HOW IS THE TEST DONE?
You may have heard this test referred to as
an” AIDS test” or an “HIV test.” In fact, it
is a test for HIV antibodies which are
produced by the body as a reaction to being
infected with the virus. A sample of your
blood is sent to a lab to be tested for the
presence of HIV antibodies. It usually takes
two to three weeks for the test result to
come back.
If you become infected with HIV, antibodies
can take up to 12 weeks to appear in your
blood. Since the test looks for antibodies
and not HIV, you need to wait until
antibodies are made by your body.
Therefore, before being tested, you must
wait at least 12 weeks after possible
exposure to HIV. This 12 week period of
time is often called the window period.

WHAT ARE THE POSSIBLE TEST
RESULTS?
A positive test result means that you have
been infected with HIV and you can pass
the virus on to others. It does not mean that
you have AIDS or that you will develop
AIDS. It does not tell you anything else
about the state of your health. You can be
infected but have no symptoms for many
years.
A negative test result means that there were
no HIV antibodies in your blood at the time
of your test. It does not mean that you are
immune to the virus or that you cannot
become infected in the future.

WHAT CAN I DO
IF I TEST HIV POSITIVE?
A health care provider who is
knowledgeable about HIV can monitor your
health and help you decide what treatments
are best for you. Your health care provider
can also discuss with you how important it
is to protect yourself from infection with
other strains of HIV or other sexually
transmitted diseases (STDs) which can
further weaken your immune system. If you
don’t know who to see, contact your local
AIDS organization or call the AIDS-Sexual
Health InfoLine at 416-392-2437 (outside
Toronto 1-800-668-2437) for health care
provider information.

BEFORE TESTING…SOME
QUESTIONS TO ANSWER
“How could I have been infected
with HIV?”
• Vaginal or anal intercourse
without a condom.
• Sharing needles while: injecting drugs
or steroids, getting a tattoo or body
piercing.
• Sharing sex toys.
• From a woman to her child during
pregnancy, birth or breastfeeding.
• Through blood transfusions before
screening of the blood supply began in
late 1985.

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Oral Sex HIV warning

The risk of contracting HIV from oral sex may be greater than previously thought.

It has long been known that the virus can be transmitted through oral sex - but the risk was thought to be minimal.

However, research in the UK and US among gay men now suggests that oral sex may be responsible for up to 8% of HIV infections.

Instead of a handful of cases a year in the UK of HIV being transmitted through oral sex, we are seeing 30 to 50
Dr Barry Evans

Other sexually transmitted diseases, such as syphilis and gonorrhoea are also spread from person to person by oral sex.

Public health experts fear that the public is unaware of the dangers associated with the practice because it remains largely a taboo subject.

In addition, anecdotal evidence from other countries like the US suggests that people tend to reject messages advising them always to use condoms for oral sex.

In fact, such messages can, in theory at least, put people off condom use altogether.

Greater awareness

A report by the Public Health Laboratory Service (PHLS) report concludes it is important for people to be more aware of the dangers and decide for themselves the level of risk they consider acceptable.

Dr Barry Evans, an PHLS expert on sexual diseases, said: "The picture that is emerging is that the risk is greater than previously thought.

"Instead of a handful of cases a year in the UK of HIV being transmitted through oral sex, we are seeing 30 to 50."

Dr Evans stressed that HIV is mostly spread through anal and vaginal sex.

Recent studies confirm that unprotected anal sex is clearly the highest risk activity, accounting for over 90% of transmission in gay men in the UK.

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Global Commission on Law urges countries to make the law work for HIV, not against it

Global Commission on Law urges countries to make the law work for HIV, not against it

Feature story

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Global Commission on Law urges countries to make the law work for HIV, not against it

11 July 2012

L to R: United States Congresswoman and member of the Global Commission on HIV and the Law, Barbare Lee; UNAIDS Executive Director Michel Sidibé; Deputy Secretary-General of the United Nations Jan Eliason; UNDP Administrator Helen Clark; and His Excellency Festus Mogae, former President of Botswana and member of the Global Commission on HIV and the Law.
Credit: D.Lowthian

The Global Commission on HIV and the Law launched its landmark report on 9 July 2012 at UN Headquarters in New York. The new report denounces the detrimental impact that punitive laws have on human rights and the HIV response and makes bold recommendations for addressing them.

“Never before has there been such an examination of the role of law in HIV,” said Festus Mogae, Former President of Botswana and member of the Commission. “What we have found is an epidemic of bad laws that is costing lives. We must end the epidemic of bad laws and enact laws based on evidence, common sense and human rights,” added Mr Mogae.

Stigma, discrimination and punitive legal approaches have long been recognized as barriers to the HIV response. They heighten vulnerability to HIV especially among key populations at higher risk of infection and make it difficult for individuals and communities to access HIV prevention, treatment, care and support services. UNAIDS has long called for the removal of punitive laws and their replacement with protective ones. Yet, countries across the world still maintain laws, policies and practices that infringe upon human rights, fuel discrimination and prevent global and national efforts to address HIV.

Speaking at the launch of the report, UNAIDS Executive Director Michel Sidibé noted that “the strength of this report is that it goes beyond a superficial description of stigma and discrimination to question the legal and structural fabrics that sustains inequality, injustice and human rights violations in the context of HIV”.

The report titled “HIV and the Law: Risks, Rights and Health” is a result of a two-year consultative process during which the Commission received more than 1 000 submissions from people affected by laws, law enforcement and access to justice issues in the context of HIV. The report took into account recommendations from 7 regional dialogues involving governments and civil society, and the input from a Technical Advisory Group of experts on HIV and the law.

Punitive laws increase risk of HIV infection

The Commission—an independent group of political and social leaders from around the world—pointed out that women in many parts of the world are governed by plural legal systems where traditional and customary law perpetuates their social and economic inequality. This situation makes women vulnerable to relationships and/or sexual violence which put them at risk of HIV infection. The Commission described the realities of many pregnant women living with HIV who face discrimination in health care including forced sterilization, even though simple and inexpensive medicine can prevent mother-to-child HIV transmission and keep mothers alive.

In the report, Commissioners called on governments to use the law to protect women from inequality and violence. They also urged governments to end legal barriers that prevent young people from accessing HIV information and services, as well as sexuality education—all necessary to avoid HIV infection.

The Commission also called for the removal of laws that criminalize people on the basis of their sexual orientation and gender identity, possession of drugs for personal use, and engagement in adult consensual sex work. It cited extensive evidence of how such criminal laws exacerbate risk of HIV infection among men who have sex with men, transgender people, people who use drugs and adults who sell and buy sex. According to the report, such laws drive people underground and into the margins of society away from health and HIV services. Furthermore, if convicted and sent to prison, the risks of contracting HIV, TB and Hepatitis C are very high because, in many countries, laws prohibit the provision of health and HIV prevention services and commodities in prisons.

We must end the epidemic of bad laws and enact laws based on evidence, common sense and human rights

Festus Mogae, Former President of Botswana and member of the Global Commission on HIV and the Law

Nick Rhoades from the Center of HIV Law and Policy spoke against the criminalization of HIV exposure and transmission, having himself been convicted in the United States of America, even though he had used condoms, had an undetectable viral load and did not transmit HIV. Citing the many HIV specific criminal laws, he said: “People have hands and can hit each other with their fists, but you don’t see a law specifically criminalizing a hand as a ‘deadly weapon’ like HIV is.” The Commission has called for the criminal law to be strictly limited to the malicious and intentional acts of actual transmission of HIV.

Participants at the launch highlighted how punitive legal approaches are undermining the investment in HIV prevention and treatment that is finally beginning to show the real possibility of halting and reversing the epidemic. They underlined that the persistence of punitive laws and practices is a serious concern at a time when the world has stabilized new HIV infections, increased its knowledge on effective HIV prevention and is preparing to harness the full potential of expanded HIV treatment. “It is outrageous that in 2012, when we have everything we need to beat this epidemic, we still must fight prejudice, discrimination, exclusion and bad laws,” said Mr Sidibé.

Law as an instrument to protect individuals

Commissioners at the launch underlined that there are many positive examples of countries that have used the law as an instrument to protect individuals, to create an environment that addresses stigma and violence thus encouraging access to HIV services. Other countries have used the law to challenge overly broad and stringent intellectual property regimes to reduce the cost of essential HIV medicines and to ensure their availability including through the production of generics.

“Law reform is complex, but countries can do much more,” said UNDP Administrator Helen Clark. “The task before us is to ensure better laws are adopted and enacted,” she added.

The Commission and its work have started dialogues across the world on issues that are difficult, controversial and complex. They are also issues that are central to human dignity, health and social justice. These dialogues are part of what Governments committed to do in the 2011 Political Declaration on AIDS where they pledged to review laws and policies that “adversely affect the successful, effective and equitable delivery of HIV services and consider their review”.

“We now have a powerful tool for advocacy and engagement to ask governments to uphold human rights for all people vulnerable to HIV,” said Ebony Johnson of the Athena Network. “This report should not be shelved.”

The Global Commission on HIV and the Law is an independent body, convened by the United Nations Development Programme (UNDP) on behalf of the Joint United Nations Programme on HIV/AIDS (UNAIDS). The Commission was supported by a Technical Advisory Group, which reviewed and analyzed existing public health and legal evidence and also commissioned original analysis. Additional information on the Commission, its processes and work is available at www.hivlawcommission.org.

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.View Photo.
Bottles of antiretroviral drug Truvada. A US advisory panel on Thursday urged US …

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US health advisers urged regulators to approve Truvada, made by Gilead Sciences, as the first preventive pill against HIV/AIDS instead of just a treatment for infected people.

The favorable vote came after clinical trials showed Truvada could lower the risk of HIV in gay men by 44 to 73 percent, and was hailed by some AIDS advocates as a potent new tool against human immunodeficiency virus.

However, many concerns were raised during a marathon 11-hour panel meeting in which about three dozen health care providers warned that the pill could boost risky behaviors and possibly lead to a drug-resistant strain of HIV.

The Food and Drug Administration is not bound by the recommendations of its expert panel, but usually follows the advice. A final decision by the FDA is expected by June 15.

Mitchell Warren, executive director of HIV prevention group AVAC, said after the vote that pre-exposure prophylaxis (PrEP), or the method of taking a drug ahead of potential exposure to HIV, "while not a panacea, will be an essential additional part to the world's success in ending AIDS."

"For the millions of men and women who remain at risk for HIV worldwide, each new HIV prevention option offers additional hope," he added.

The drug, made by the California-based Gilead Sciences, is currently available as a treatment for people with HIV in combination with other anti-retroviral drugs, and received FDA approval in 2004.

The panel's nod came in response to the pharmaceutical company's request for a supplemental new drug application to market it for prevention purposes.

The Antiviral Drugs Advisory Committee voted for the drug as a preventive measure for three groups: 19-3 in favor for men who have sex with men, 19-2 with one abstention for couples in which a partner is HIV positive and 12-8 with two abstentions for other at-risk groups.

Gay men account for more than half of the 56,000 new HIV cases in the United States each year, according to the Centers for Disease Control and Prevention (CDC).

But critics noted that the pill is costly -- up to $14,000 per year -- and could offer a false sense of protection, leading to a spike in unsafe sex and a new surge in AIDS cases.

"We need to slow down. I care too much about my community not to speak my concerns," said Joey Terrill, advocacy manager at the AIDS Healthcare Foundation, which campaigned against the drug's approval for PrEP.

There also remains some controversy about who would benefit from the treatment, as trials in women have shown feeble results, possibly due to poor adherence to the regimen.

"I am concerned about the potential for development of resistance," said Roxanne Cox-Iyamu, a doctor who spoke at the panel's meeting.

"I am concerned as a black woman that we don't have enough data that this actually works in women."

Nurse Karen Haughey said Truvada will not work because "it is not in our nature to always do as human beings what we are told 100 percent of the time."

She also said Truvada's main side effects -- diarrhea and risk of kidney failure -- were a major deterrent.

The main set of data considered came from the iPrEx HIV Prevention Study, carried out from July 2007 to December 2009 in six countries -- Brazil, Ecuador, Peru, South Africa, Thailand and the United States.

The study was conducted among 2,499 men who were sexually active with other men but were not infected with the virus that causes AIDS.

Participants were selected at random to take a daily dose of Truvada -- a combination of 200 milligrams of emtricitabine and 300 milligrams of tenofovir disoproxil fumarate -- or a placebo.

Those in the study who took the drug regularly had almost 73 percent fewer infections. Across the entire study, including those who had not been as diligent in taking Truvada, there were 44 percent fewer infections than in those who took a placebo.

After publication in 2010 in the New England Journal of Medicine, some experts hailed the results as game-changing and the first demonstration that an already-approved oral drug could decrease the likelihood of HIV infections.

Joseph McGowan, medical director of the Center for AIDS Research and Treatment at North Shore University Hospital in New York, said the CDC was expected to soon issue guidance for health professionals who may prescribe the drug.

"I don't see it as something that would be useful to the general public but to certain people who are particularly high risk, there may be some benefit," he said.

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